Outcome of sonography-based minimally invasive surgery for deep infiltrating endometriosis of the ureter and urinary bladder - a retrospective cohort study

Abstract

Introduction: The aim of this study was to evaluate the accuracy of transvaginal sonography for preoperative detection of bladder endometriosis and surgical outcomes regarding fertility and pain symptoms of women with urinary tract endometriosis.

Material and methods: Retrospective cohort study of consecutive patients with urinary tract endometriosis undergoing laparoscopic partial cystectomy and/or ureterolysis/decompression, ureteric resection and end-to-end anastomosis or ureteroneocystostomy for ureteral stenosis and hydronephrosis.

Results: Of 207 patients with deep infiltrating endometriosis, 50 exhibited urinary tract endometriosis, comprising 30 patients with bladder endometriosis and 23 women with solitary or additional hydronephrosis. Sensitivity, specificity, positive and negative predictive value, positive/negative likelihood ratios and test accuracy for transvaginal sonography detecting bladder endometriosis were 93%, 99%, 97%, 99%, 155.5, 0.07 and 98.6% respectively. All women with bladder endometriosis underwent partial cystectomy. In cases of hydronephrosis, 14 conservative ureterolysis/decompressions, six ureteral resection anastomoses and three ureteroneocystostomies were performed. Duration of surgery was 205 min (range 89-365 min), average blood loss was 1.6 g/dL (range 0.3-4.6 g/dL) and hospital stay on average 8 days (range 2-16 days). The conversion rate was 4%. We observed five grade III complications. After a median follow up of 23 months, there was a decrease in dysmenorrhea (7.6-1.6; p < 0.001), dyspareunia (3.0-0.9, p < 0.001) and dysuria (3.3-0.2; p < 0.003), and an increase in quality of life (3.3-8.1; p < 0.001). The overall clinical pregnancy rate was 46% and life birth rate 18%.

Conclusions: Laparoscopic surgery for urinary tract endometriosis is effective for treatment of hydronephrosis, reduction of pain symptoms and may improve fertility. Transvaginal sonography is highly accurate for presurgical detection of bladder involvement.

Keywords: Endometriosis; hydronephrosis; transvaginal sonography; ureteral stenosis; urinary bladder.